HHS Public Access Author manuscript Author Manuscript

Melanoma Res. Author manuscript; available in PMC 2016 August 01. Published in final edited form as: Melanoma Res. 2016 August ; 26(4): 387–394. doi:10.1097/CMR.0000000000000268.

BRAF inhibitor and stereotactic radiosurgery is associated with an increased risk of radiation necrosis Kirtesh R. Patela,*, Mudit Chowdharya,*, Jeffrey M. Switchenkob, Ragini Kudchadkarc, David H. Lawsonc, Richard J. Cassidya, Roshan S. Prabhud, and Mohammad K. Khana aDepartment

of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta,

Georgia

Author Manuscript

bDepartment

of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia

cDepartment

of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia dSoutheast

Radiation Oncology Group, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina, USA

Abstract

Author Manuscript Author Manuscript

We retrospectively compared the outcomes and toxicities of melanoma brain metastases (MBM) patients treated with BRAF inhibitors (BRAFi) and stereotactic radiosurgery (SRS) with SRS alone. We identified 87 patients with 157 MBM treated with SRS alone from 2005 to 2013. Of these, 15 (17.2%) patients with 32 MBM (21.4%) received BRAFi therapy: three (20.0%) before SRS, two (13.3%) concurrent, and 10 (66.7%) after SRS. Overall survival (OS) was compared between cohorts using the product limit method. Intracranial outcomes were compared using cumulative incidence with competing risk for death. Baseline patient characteristics were similar between groups, except for the SRS cohort, which had higher rates of chemotherapy and more recent year of diagnosis. Radiation characteristics, including dose per fraction, total dose, gross tumor volume size, and prescription isodose, were also similar between cohorts. One-year outcomes – OS (64.3 vs. 40.4%, P =0.205), local failure (3.3 vs. 9.6%, P =0.423), and distant intracranial failure (63.9 vs. 65.1%, P =0.450) were not statistically different between the SRS + BRAFi and SRS-alone groups, respectively. The SRS + BRAFi group showed higher rates of radiographic radiation necrosis (RN) (22.2 vs. 11.0% at 1 year, P

BRAF inhibitor and stereotactic radiosurgery is associated with an increased risk of radiation necrosis.

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